<form action="{:url()}" method="post" class="form_single">
    <div class="box">
      <div class="box-body">
        <div class="row">
          <div class="col-md-6">
            <div class="form-group">
              <label>机构名称</label>
              <span>（机构名称）</span>
              <input class="form-control" name="name" placeholder="请输入机构名称" value="{$info['name']|default=''}" type="text">
            </div>
          </div>
            
          <div class="col-md-6">
            <div class="form-group">
              <label>机构编号</label>
              <span>（填写机构标准编号）</span>
              <input class="form-control" name="id" placeholder="请输入机构编号" value="{$info['id']|default=''}" type="text">
            </div>
          </div>

          <div class="col-md-6">
            <div class="form-group">
              <label>联系人姓名</label>
              <span>（填写联系人姓名）</span>
              <input class="form-control" name="leader_name" placeholder="请输入联系人姓名" value="{$info['leader_name']|default=''}" type="text">
            </div>
          </div>            

          <div class="col-md-6">
            <div class="form-group">
              <label>联系人身份证号</label>
              <span>（填写联系人身份证号）</span>
              <input class="form-control" name="leader_code" placeholder="请输入身份证号" value="{$info['leader_code']|default=''}" type="text">
            </div>
          </div>
                      
          <div class="col-md-6">
            <div class="form-group">
                <label>所属行政区域</label>
                <span>（所属行政区域）</span>
            {:widget('region/index', ['province' =>$info['county_id'], 'city' =>$info['town_id'],'county'=>$info['id'],'name'=>'id'])}
            </div>
          </div>
            

            
          </div>
        </div>
        
      <div class="box-footer">
          
        <input type="hidden" name="id" value="{$info['id']|default='0'}"/>
        
        {include file="layout/edit_btn_group"/}
        
      </div>
        
      </div>

</form>